March 5, 2011

021 Semmelweis – a lesson of arrogance [20 July 2009]

Ignaz Semmelweis (1818-1865) was a Hungarian physician working in the obstetrical ward of Vienna General Hospital in the late 1840s. He was greatly distressed by the high death rate from childbed fever in his ward, which at 18% was 4-5 times greater than that of the other division attended by midwifery students.

One day in 1847 while Semmelweis and his colleagues were performing an autopsy between deliveries (a routine occurrence), one of the doctors cut his finger with a scalpel. Within a few days he developed symptoms similar to childbed fever and soon died. As a result of this, Semmelweis instructed his medical students to wash their hands with chlorinated lime water before attending patients. This simple rule lowered the mortality rate to 1.3%.

Semmelweis’ great discovery, however, was met with hostility and ridicule from his colleagues and from the Viennese Medical Society. He was forced to return to Hungary, where he instituted his handwashing rule in a hospital in Pest with similar success. Despite the undeniable evidence, physicians throughout Europe rejected the idea that their actions could be the cause of childbed fever, and drove Semmelweis into a mental asylum where he died in 1865.

What lessons can we learn from this story? One is that it takes time for new ideas to be accepted. Semmelweis was just a few years ahead of his time, His theory of lack of cleanliness as a cause of disease didn’t fit with the accepted theories of his day. Within a few years of Semmelweis’ death, Louis Pasteur convinced most scientists of his germ theory of disease, and Joseph Lister developed antiseptic surgical practices. Semmelweis is now considered a pioneer of antiseptic procedures.

Another lesson is that confrontation rarely brings the desired outcome. Frustrated with the knowledge that his discovery could save the lives of thousands of women, Semmelweis wrote increasingly angry letters to obstetricians who opposed his theory, accusing them of ignorance and even of murder. Patiently and accurately communicating your ideas to others is more effective than accusatory name calling.

A final lesson is that arrogance within a health (or any) profession is detrimental to progress. We all should be able to welcome, and look objectively at, new evidence affecting our practices, and be ready to make changes accordingly. Future columns will explore more recent examples showing that we still have this lesson to learn.

For more on this fascinating chapter in the history of health care, see:

This article is intended for educational purposes only; for medical advice consult your licensed health practitioner.

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